23 Miss. Code. R. 102-7.5 - Independent Disability Determinations

A. An independent disability determination when a separate Medicaid application has been filed under one of the following circumstances:

1. The individual has not applied for SSI or has applied and been denied for a reason other than disability;

2. An individual applies separately for both SSI and Medicaid and SSI fails to make a decision within ninety (90) days.

a) In this instance, DDS must provide Medicaid with a decision prior to the SSI decision.

3. An individual applies for Medicaid and alleges a disabling condition that is different from, or in addition to, that considered by SSA.

4. An individual meets all three (3) of the criteria below:

a) Applies for Medicaid more than twelve (12) months after SSA last made a final determination that the individual was not disabled; and

b) The individual alleges his condition has deteriorated since that final decision; and

c) The individual has not reapplied for SSI.

B. If the above conditions do not exist and the individual is potentially eligible for SSI, he must file or re-file for SSI benefits. This does not mean a separate Medicaid application cannot be filed; however, Medicaid eligibility decision will be tied to the SSI decision.

1. Example: An individual applied for SSI and was denied due to disability in June 2008. In October 2008, the individual files for Medicaid only, but alleges no change in his physical condition since his SSI application was denied. In this case, the SSI disability denial controls the Medicaid decision. The individual must be denied Medicaid eligibility based on the previous SSI denial and referred to SSA to reapply for SSI.

Notes

23 Miss. Code. R. 102-7.5

Miss. Code Ann. § 43-13-121.1 (Rev. 2005).